Program Manager, Medicare Stars & Quality Improvement (Remote in Idaho)

Molina Healthcare; Twin Falls (ID); Remote; USD 73,000 - 143,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare seeks a senior leader to provide subject matter expertise and leadership for Medicare Stars quality improvement (QI) programs and activities. This role guides planning, implementation, and outcomes measurement across enterprise and health plans, delivering impactful QI initiatives from design through completion.

The candidate will lead cross-functional teams, manage budgets, track KPIs, and develop requirements and training materials to support improved Star ratings.

Qualifications

• At least 6 years of Medicare Stars program and project management experience.
• Demonstrated knowledge of Medicare Star ratings and QI programs.
• Advanced knowledge of quality metrics and performance standards.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures supporting business objectives.
• Strong business writing and communication skills.
• Ability to work independently in a fast-paced environment.
• Strong project management experience.

Responsibilities

• Collaborate with cross-functional teams to develop and implement enterprise Medicare Stars QI programs.
• Manage, plan and execute Medicare Star ratings programs.
• Support Stars program execution and governance; communicate outcomes and develop initiatives.
• Lead programs to meet critical needs and provide recommendations to leadership.
• Transform needs into functional requirements to maximize improvement opportunities.
• Monitor KPIs and outcomes across Stars and QI initiatives.
• Create business requirements, test plans and training materials.
• Oversee vendor work as needed.

Skills

Medicare Stars

QA/QI

Project management

Data analysis

Cross-functional collaboration

Strategic thinking

Communication skills

Education

Bachelor's degree or equivalent

Tools

Microsoft Office

Excel

Job description

JOB DESCRIPTION Job Summary

Provides subject matter expertise and leadership for Medicare Stars quality improvement (QI) programs and activities. Provides subject matter expertise in planning and implementing QI initiatives and education programs to support improved Medicare Star ratings. Responsible for leading and managing Medicare Star projects and programs involving enterprise, department, cross-functional and health plan teams of subject matter experts, delivering impactful quality improvement initiatives through design process to completion and outcomes measurement.

Essential Job Duties

• Collaborates with cross-functional corporate and health plan teams on the development and implementation of enterprise Medicare Stars quality improvement (QI) programs and initiatives across the enterprise.
• Manages, plans and executes Medicare Star ratings programs.
• Supports Stars program execution and governance needs; communicates, measures outcomes and develops initiatives to improve Star ratings.
• Serves as the Medicare Stars subject matter expert to corporate functional areas/health plans, and leads programs to meet critical needs.
• Communicates and collaborates with health plans and Stars measure owners to analyze and transform needs and goals into functional requirements to maximize improvement opportunities.
• Leads health plan leadership discussions to provide recommendations, performance results and opportunity assessments for Medicare Stars improvement.
• Collaborates with operational leaders within the business to provide recommendations on opportunities for process improvements, organizational change management, program management and other processes related to Medicare Star ratings.
• Facilitates process improvement, organizational change management, program management and other processes relative to the Medicare Stars Program.
• Plans and directs schedules for program initiatives, as well as program budgets.
• Develops, defines, and executes plans, schedules, and deliverables; monitors programs from initiation through delivery through outcomes measurement.
• Monitors and tracks key performance indicators (KPIs), programs and initiatives to reflect the value and effectiveness of Stars and QI programs.
• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documents.
• Monitors projects from inception through delivery and outcomes measurement.
• May engage and oversee the work of external vendors.
• Generates and distributes quality improvement/Medicare Stars standard reports timely.

Required Qualifications

• At least 6 years of Medicare Stars program and project management experience, or equivalent combination of relevant education and experience.
• Demonstrated knowledge of and experience with Medicare Star ratings and QI programs.
• Advanced knowledge of the quality discipline, including metrics and performance standards.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures that support business objectives.
• Solid business writing experience.
• Strong strategic-thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Strong project management experience.
• Excellent verbal, written, and presentation communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Strong Medicare Stars/quality improvement (QI) program experience.
• Six Sigma Black Belt Certification.
• ITIL (Information Technology Infrastructure Library) certification.
• Experience in leading significant cross-functional work.
• Strong project management experience.

• Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $73,102 - $142,549 / ANNUAL

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.